posted
Okay, but why is that guy leaning against that tree?
Posts: 204 | From ma | Registered: May 2007
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bettyg
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posted
copying this here fur neuros like me; breaking up...betty
CHARLES FOX / Staff Photographer
Curt Lorraine needs extended IV antibiotics for Lyme disease, his doctors say. Long-term treatment has been controversial, and his insurer did not pay until the eve of a court hearing.
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Posted on Tue, Aug. 11, 2009
A Lyme treatment pits doctors, insurer By Stacey Burling
Inquirer Staff Writer
Curt Lorraine, 61, an unemployed Collegeville man, fought an insurance giant and won.
Lorraine's lawyer, David Senoff, said Independence Blue Cross gave in to his client's demand that it cover extended intravenous antibiotics for Lyme disease, a treatment Lorraine's doctors say is needed to save his sight.
But the insurer waited until the eve of a court hearing last week on a motion to compel payment.
That, Senoff said, shows what it sometimes takes to get medical care.
"Why is it that a guy like this has to go through all these machinations?" he asked. "This is how these companies operate. The only thing they really understand is when somebody puts a gun to their head."
It's easy to see Lorraine's case simply as one man having to fight to get what the doctor ordered.
But the issue is far more complicated than that, and it highlights a thorny issue in health-care reform:
Who should decide what is the best care, a patient's doctors, a consensus of experts, or the insurer?
A spokeswoman for Independence Blue Cross said she could not discuss Lorraine's case because of privacy laws.
The company covers IV therapy for up to four weeks under some circumstances.
Its written policy says that "there is no data to suggest that prolonged or repeated courses of IV antibiotics are effective."
Gary Wormser, a Lyme expert and infectious-disease specialist at New York Medical College, questions whether most people said to have chronic Lyme disease - symptoms that persist after initial treatment - are suffering from Lyme at all. Lyme can clearly cause arthritis later, he added.
For years, the use of long-term IV antibiotics for Lyme, which is caused by tick-borne bacteria, has been extremely controversial among doctors and patients.
The Centers for Disease Control and Prevention says courses of IV antibiotics beyond four weeks are "not beneficial" and "have been linked to serious complications, including death."
Wormser said he believes IV antibiotics should be reserved for patients who test positive for current infection with the bacteria and should be used only until the infection is gone.
He called eye problems a very unusual complication of Lyme disease.
Few insurance companies will pay for extended courses of antibiotics, said Karen Vanderhoof-Forschner, chair of the board of the Lyme Disease Foundation.
Connecticut is the only state in the country that requires coverage of IV therapy for more than 28 days - if two doctors agree it's necessary - and that law is under review, she said.
Patients sometimes spend hundreds or thousands of dollars out of pocket for the treatments, she said.
Lorraine, who said he pays more than $600 a month for his health insurance, discovered a tick on his leg on June 25, 2007.
About two weeks later, he had pains across his neck and shoulders "so bad that it made me cry." The right side of his face became paralyzed. He ended up in the hospital and received a month of IV antibiotics.
In summer 2008, B. Stephen Burke, an internal-medicine doctor in West Chester who specializes in Lyme, ordered another round of antibiotics because Lorraine's symptoms persisted.
Blue Cross refused, and Lorraine paid $3,000 for the treatment. (He has sued Blue Cross over that, too.)
Lorraine said he began having eye problems in 2006, before he saw the tick. His ophthalmologist, Bruce Saran, said Lorraine has inflammation in various parts of his eye that he thinks could be caused only by Lyme disease.
He and Burke believe Lorraine probably had previous exposure to the disease.
Saran said he usually thinks that the standard 28 days of IV antibiotics is enough but that Lorraine is an "exception to the rule."
With Saran's concurrence, Burke ordered a different IV antibiotic this spring.
Blue Cross paid for that but denied an extension after Burke said Lorraine was improving and needed more of the drug.
The idea that a month of treatment is enough for everyone is "just rubbish," Burke said.
Senoff estimated another round of IV antibiotics would have cost Lorraine $5,000.
Lorraine said he's still easily fatigued and has joint pain throughout his body.
He said he has a rash around his eyes and his whole face hurts. There are stinging pains in his feet. Cloudy patches float across his eyes.
He's looking forward to starting treatment again.
"I'm just really happy I can be on the treatment I deserve," he said.
Contact staff writer Stacey Burling at 215-854-4944 or [email protected]
posted
Medicare part D certainly pays for IV antibiotics. We need to explain to these misinformed whackjobs that are throwing fits about health care reform what the true benefits are. That and the corruption involved in our private system.
Posts: 499 | From Indiana | Registered: Oct 2007
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